MEDICARE: ALFIE MARIE WEATHERS STNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	376K00000X	Nurse's Aide	32004720795	OH

General Provider Information

NPI Number	:	1407276843
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALFIE MARIE WEATHERS STNA

Provider Business Mailing Address
First Line	:	569 STEWART AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43206-2867
Country	:	US
Telephone Number	:	614-212-0843
Fax Number	:

Provider Business Practice Location Address
First Line	:	569 STEWART AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43206-2867
Country	:	US
Telephone Number	:	614-212-0843
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/24/2014
Last Update Date	:	04/24/2014

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Directions to “ ALFIE MARIE WEATHERS STNA” Practice Location

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